Schön Klinik Vogtareuth, Gait and Motion Analysis Laboratory, Krankenhausstraße 20, 83569, Vogtareuth, Germany.
Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229, Aschau im Chiemgau, Germany.
Gait Posture. 2020 Mar;77:225-230. doi: 10.1016/j.gaitpost.2020.01.014. Epub 2020 Jan 21.
There is considerable debate as to which parameters to include in the assessment of paediatric flatfeet. Dynamic pedobarography is an objective, dynamic method to measure foot function. Information about its associations to patient-reported measures may help to focus on the most relevant parameters.
What is the association between the Foot Function Index and pedobarographic assessments in flatfeet of children and adolescents?
A consecutive clinical case series of 51 participants with idiopathic flexible flatfeet aged 7-17 years underwent barefooted pedobarography during gait and completed the Foot Function Index Questionnaire. Pedobarographic data categorized into values related to area, peak pressure and force with respect to the hind-, mid- and forefoot were extracted. To test the associations between the Foot Function Index and pedobarographic assessments, bivariate partial correlations were tested and contact times served as co-variate.
Several significant associations between peak pressure or forces beneath the hindfoot, midfoot and hallux to self-perceived function were found (|rho| = 0.28-.46, P < 0.05). In particular, reduced peak forces and pressures underneath the hindfoot and hallux, a lateral shift (smaller medio-lateral ratios) of hindfoot pressure and force and a medial shift (larger medio-lateral ratios) of midfoot pressure seem to be negatively associated with foot-related disability. Overall, less evidence was noted for associations to pain scores. Area related outcomes (including the arch index) contained no information for function while a larger BMI was the strongest thread for disability (rho = 0.42, P = 0.002) and pain (rho = 0.31, P = 0.027).
When using pedobarography for the assessment of flexible flatfeet of children and adolescents, less attention should be paid to area related measurements which do not provide information about self-perceived function or disability. Instead, peak pressures or forces in the hind- or midfoot or beneath the hallux may be focussed. Weight reductions are potentially an effective strategy to reduce or prevent symptoms.
在评估儿童扁平足时，应该包含哪些参数存在相当大的争议。动态足底压力计是一种客观、动态的测量足部功能的方法。了解其与患者报告测量结果的关联可能有助于关注最相关的参数。
儿童和青少年特发性柔韧性扁平足的足部功能指数与足底压力计评估之间有什么关联？
对 51 名年龄在 7-17 岁的特发性柔韧性扁平足患者进行了连续的临床病例系列研究，这些患者在步态中进行了赤脚足底压力计检查，并完成了足部功能指数问卷。从与后跟、中足和前足相关的区域、峰值压力和力值中提取出足底压力计数据。为了测试足部功能指数与足底压力计评估之间的关联，进行了双变量偏相关检验，并将接触时间作为协变量。
在自我感知功能方面，发现后跟、中足和大脚趾下的峰值压力或力与多个显著相关（|rho|=0.28-0.46，P<0.05）。特别是，后跟和大脚趾下的峰值力和压力降低、后跟压力和力的外侧移位（较小的中侧比）以及中足压力的内侧移位（较大的中侧比）似乎与足部相关的残疾呈负相关。总体而言，与疼痛评分的关联证据较少。与面积相关的结果（包括足弓指数）与功能无关，而较大的 BMI 是残疾（rho=0.42，P=0.002）和疼痛（rho=0.31，P=0.027）最强的关联因素。
在评估儿童和青少年柔韧性扁平足时，应该减少对与面积相关的测量的关注，这些测量不能提供自我感知功能或残疾的信息。相反，应关注后跟或中足或大脚趾下的峰值压力或力。减重可能是减轻或预防症状的有效策略。
